Health Coaching Reduced COPD-related Hospitalizations

Study Shows Benefits of Health Coaching Plus a Written Action Plan

Background: There is considerable attention focused on preventing hospital readmissions for COPD. One factor is that hospitals are penalized by lower reimbursement for services if there is a high readmission rate.

first author of study evaluating health coaching

Dr., Roberto Benzo of the Mayo Clinic.

Study: Dr. Roberto Benzo and colleagues at the Mayo Clinic in Rochester, MN, studied a total of 215 patients hospitalized for a COPD flare-up (called an exacerbation). At discharge from the hospital, one-half were assigned to health coaching and a written action plan for any flare-up OR usual care. 

The health coach met with each patient in the hospital for 2 hours and at least once in person after discharge. At the first visit, the patient was provided with prednisone and an antibiotic to be started if the individual experienced a flare-up. Also, during the visit self-management concepts, goal setting, action planning, and details of the telephone sessions to come were discussed. All subsequent sessions were conducted by telephone.

The study was published in the September 15, 2016, issue of the American Journal of Respiratory and Critical Care Medicine (volume 194; pages 671-680).

Health coach aims for healthy lives.

A health coach can help someone achieve a healthy life.

Results: There was a significant reduction in hospital readmissions at 6 months, but not at one year, in the group who received health coaching compared with usual care. The health coaching group also had better quality of life than the usual care group. 

Conclusions: The authors concluded that their study was the first to show the benefits of “a feasible, innovative, and effective intervention designed to reduce short-term readmissions for those with COPD.”

My Comments: Health coaching is popular in managed care and accountable care organizations (ACOs) in an effort to improve care and to reduce costs. Health coaching is patient-centered, individualized, and aimed at improving health behaviors. For those with COPD, a health coach may assist the individual with quitting smoking, increasing physical activity, and starting early treatment for a flare-up. Whether health coaches will become an integral part of medical practices in the future is unknown.

 

Less than 20% Receive Education About Monitoring a COPD Flare-up

Results of Study Show Need for a COPD Flare-up Action Plan

Less than 1 of 5 patients with COPD received information from their doctors on how to self-monitor for signs of an impending COPD flare-up according to Anja Frei, Ph.D., of the University of Zurich. Dr. Frei presented these findings at the International Conference of the European Respiratory Society in London. A flare-up means an increase in cough, mucus production, and/or more short of breath. About 2/3 of flare-ups are due to a chest infection (bacterial or viral), while about 1/3 are due exposure to air pollution. The medical word for a COPD flare-up is an exacerbation. 

Photo on right shows acute bronchitis with yellow mucus inside the airway

Photo on right shows acute bronchitis with yellow mucus inside the airway. This can cause a COPD flare-up.

 

Of 317 individuals with COPD living in Switerzerland who were surveyed,  just 53 remembered ever being told to monitor their own symptoms. About 36% recalled being given instructions to change medications in case of deteriorating breathing. 29% of those COPD took action when a flare-up occurred; some called their primary care provider, some used short-acting albuterol inhaler for relief, and others avoided aggravating situations.

Primary care providers discussing Action Plan for COPD flare-up

Primary care providers discussing Action Plan for COPD flare-up

According to Claudia Steurer-Stey, M.D., “We have a lot of work to do in education of these patients. The general practioner who sees the majority of their patients is a very important target of our work so they can improve the quality of primary care.”

My Comments: All those with COPD should have a written action plan for what to do if/when they an experience a COPD flare-up.

Here is a Simple COPD Action Plan if You Have a Flare-up

♦ If you are more short of breath, use albuterol sulfate and/or ipratropium bromide inhalers every 2 – 4 hours as needed

Albuterol sulfate – brand names are ProAir, Proventil, and Ventolin

Ipratropium bromide – brand name is Atrovent

Combination of albuterol sulfate and ipratropium bromide –

brand names are Combivent Respimat and DuoNeb solution (in nebulizer)

♦ If you cough up yellow or green mucus, call or see your health care provider to ask if an antibiotic is appropriate.

♦ If use of albuterol sulfate and/or ipratropium bromide does not help improve your breathing difficulty, call or see your health care provider to ask if prednisone is appropriate.

♦ If you cannot speak in full sentences or cannot fall asleep at night because of breathing difficulty, call or see your health care provider, go to an Urgent Care center, or go to the nearest Emergency Department.

 

 

 

 

Health Literacy and Best Care for COPD

Only 12% of Adults in US have Good Health Literacy

What is health literacy?  It means being able to access, read, understand, and use health information. In 2006 the U.S. Department of Health and Human Services reported that only 12% of American adults were considered to have good or proficient health literacy.

This is different than intelligence. Dr. Suni Kripalani from Vanderbilt University Medical Center in Nashville, TN, said, “People may be educated and functioning fine in other contexts, but may struggle to navigate the health care system.” The increasing use of technology and the availability of information on the internet make it quite challenging for many individuals.

What does this mean? Low health literacy may mean: ♦ difficulty in listening and following instructions from your health care provider ♦ making sense of medical words or jargon ♦ completing health insurance forms or questionnaires   ♦ challenges in making decisions about taking medications or surgery

Why is this important? Low health literacy has been linked to: ♦ poor health outcomes such as higher rates of hospitalization ♦ less frequent use of preventive services such as vaccinations and cancer screening ♦ increased risk of making mistakes with medications ♦ poorer control of chronic diseases

Maintaining health literacy involves listening, interacting with health care professionals, and closely following instructions.

Maintaining health literacy involves listening, interacting with health care professionals, and closely following instructions.

What does this mean if you have COPD? First, it is important for you to know as much as possible about your COPD. In 2015, I wrote a book titled COPD: Answers to Your Questions to provide basic information for those interested in learning more about COPD. It is available on Amazon and costs $14.95.  Second, make sure that you know how to use your inhalers. Remember, the medication only works if it gets deep into the breathing tubes. If you are not sure that you are using correct technique, ask the nurse or your health care provider to watch you inhale the medication. Third, keep a list of all of your medications and carry this with you. You should know exactly when you should use the inhaler(s) – either on schedule for maintenance medications or as needed for others. Fourth, have a written Action Plan in case you experience sudden breathing difficulty such as a chest infection. Know what to do! Ideally, you want to prevent the need to go to the Emergency Department of the nearest hospital.

Good health literacy is continuing to learn so that you have the best possible outcomes.

Preventing Hospital Readmission for COPD Exacerbation

An exacerbation of COPD means a worsening of symptoms including more shortness of breath, increased coughing, and possible coughing up more mucus, especially if the color is yellow or green. If the exacerbation is severe, it may require hospitalization for treatment.  Starting in October 2014, hospitals in the United States have been judged on their ability to reduce 30-day, all-cause unplanned readmissions for COPD after an initial hospitalization for a COPD exacerbation. The U.S. Centers for Medicare and Medicaid Services (CMS) will penalize hospitals for what they consider excessive admissions. In a 2015 editorial in the Journal of COPD Foundation (volume 2; pages 4 – 7), Dr Sidney Braman of the Icahn School of Medicine at Mount Sinai in New York City commented on strategies for preventing hospital readmissions for those with COPD.

Dr. Sidney Braman, Professor of Medicine

Dr. Sidney Braman, Professor of Medicine

 

This information directly applies to someone who has COPD because everyone wants to stay out of the hospital unless it is necessary.

Dr. Braman outlined four elements of medical care:

  1. COPD guideline-directed treatment protocols for Emergency Department visits and hospitalized patients
  2. patient/caregiver education on smoking cessation, inhaler use and an Action Plan for an exacerbation
  3. patient assessment of oxygen needs, medical conditions other than COPD, goals of care, and breathing tests
  4. a follow-up plan that includes a phone call at 48-72 hours after discharge, a visit within 7-10 days with a health care provider, participation in pulmonary rehabilitation when available, and appropriate use of community home care services.

An Action Plan is important so that you know what to do if you experience more  breathing difficulty. Here are four steps of an Action Plan that you can consider and discuss with your doctor.

Step 1. If your have more shortness of breath:
>use pulse-lips breathing
>try to relax
>use your rescue inhaler. For most, this will be albuterol aerosol from an inhaler. Alternatively, albuterol can be inhaled as a solution from a nebulizer. Other rescue medications are ipratropium (Atrovent) and albuterol and ipratropium combination (Combivent) inhaled as a mist or a solution from a nebulizer.

Step 2. If you cough up yellow or green mucus, then most likely you have a bacterial chest infection. You should contact your doctor to ask about an antibiotic. White-gray mucus suggests either inflammation or a viral infection. Remember, we do not have effective antibiotics for most viruses that cause a chest infection (bronchitis or pneumonia).

Step 3. If your breathing is much worse and the rescue medication is not helping enough, you should contact your doctor to ask about prednisone. This medication fights inflammation which develops in your breathing tubes when a chest infection occurs.

Step 4. If your breathing difficulty becomes quite severe, you need to go to the nearest Emergency Department. Either have someone drive you there or call 911 for an ambulance.